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ECG Course IV: ST-T Deviations & QT Prolongation

This document discusses ST and QT abnormalities seen on electrocardiograms (ECGs). It aims to help students diagnose ST segment elevation, identify acute myocardial infarction (AMI) and other causes of ST elevation. The document reviews how to diagnose ST depression and understand T wave inversion. It provides information on ECG changes seen in coronary heart disease, how to locate AMI based on which leads show ST elevation, and non-AMI causes of ST elevation like early repolarization and pericarditis.

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179 views18 pages

ECG Course IV: ST-T Deviations & QT Prolongation

This document discusses ST and QT abnormalities seen on electrocardiograms (ECGs). It aims to help students diagnose ST segment elevation, identify acute myocardial infarction (AMI) and other causes of ST elevation. The document reviews how to diagnose ST depression and understand T wave inversion. It provides information on ECG changes seen in coronary heart disease, how to locate AMI based on which leads show ST elevation, and non-AMI causes of ST elevation like early repolarization and pericarditis.

Uploaded by

api-3757039
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd

E.C.G.

Course – IV
ST – T Deviations
and QT
prolongation
Dr. Michael Kassirer

”Dept. Internal Medicine ”D


Tel-Aviv Medical center
Objective
By the end of lesson 4 the student will:
 Be able to diagnose ST segment elevation,
identify and locate AMI, and other causes of
ST segment elevation.
 Describe the sequence of ECG events in
AMI
 Know how to diagnose ST depression.
 Understand the importance of T wave
inversion
ECG changes in CHD -
summery
 T wave inversion –
Ischemia
 ST deviation:
– Elevation – Injury
(trans-mural)
- Depression –
Ischemia (Sub-
endocardial).
- Reciprocal Infarct Injury Ischemia
changes
 QRS: Infarct

– decreased R
- Q wave
The QRS complex – V.
depolarization

V1 V6

L3 L2
The QRS complex – V.
depolarization

V1
V1 V6

L3 L2
The QRS complex – V.
depolarization

V1
V1 V6

L3 L2
The QRS complex – V.
depolarization

V1
V1 V6

L3
L3 L2
ST changes in Ischemia
))Phase 2 changes
Injur Ischemia
y

V1 V6 V1 V6

L3 L2
L3 L2
AMI – ECG evolution
ST elevation and MI
location
ST ↑ in leads…Position Occ. Artery
V1-3 Anterior LAD
V2-4 Septal/Apical mid LAD
V5-6 (± L1, aVL) Lateral LCx or D1/M1
V1-6 Ext. Antrior L.M or Prox. LAD
Inferior (RCA (80%
L2, L3, aVF
High lateral M1 or D1
L1, aVL
Posterior LCx
V7-9 RV RCA
V2R-4R
?Where is the MI
?Where is the MI
?Where was the MI
ST elevation – non AMI

arly repolarization Pericarditis


ST elevation – non AMI

L.B.B.B Hyperkalemia
ST - T depression
T wave inversion
 Evolving MI/NSTEMI
 Old MI
 Myocarditis
 LVH/RVH strain
 Cerebral T wave
T wave inversion

LVH/RVH + Strain Digitalis effect

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